The devastation from the coronavirus was not akin to the seasonal flu. After all, those deaths occurred even with the economy stopping and then restarting only slowly, and those deaths happened even with broad efforts by people in most states to wear masks and maintain safe distancing practices. While fewer deaths would have occurred had the government acted more quickly, had life simply continued as normal, the toll would obviously have been far higher.
Or, perhaps, not obviously. After President Trump contracted the virus at some point in the past two weeks, it seemed like a moment in which the gravity of the pandemic might finally weigh on him in a way it perhaps hadn’t since the outbreak began. But after a quick stint in the hospital, Trump emerged on Monday claiming to feel as good as he did 20 years ago — and resuscitating his rhetoric from seven months ago.
This is wrong both in the specifics and the abstract, and obviously so.
There are two ways that epidemiologists measure the toll from each flu season. Each week, the government tallies hospital visits, confirmed flu tests and flu-related deaths. Those data are used to build out estimates of the overall spread of the virus over each winter, what the Centers for Disease Control and Prevention calls the “flu burden.”
Some seasons are worse than others. The graphs below show the flu burden each year from the 2011-2012 season to estimates for the 2019-2020 season. In the 2012-2013 season, identified in blue, the CDC estimates that about 9.3 million Americans were symptomatic and 12,000 died. (The horizontal lines mark the estimate; the bars above and below are the range of possible values.) In the 2017-2018 season (dark orange), 45 million people were infected, and an estimated 61,000 died.
You will notice that even the upper bound of possible deaths in the 2017-2018 season doesn’t hit 100,000. Trump is wrong when he says that the flu kills that many people each year. It takes something exceptional — like the flu pandemic of 1968 — for that many people to die.
It’s important to note as well that when we compare the current coronavirus death toll to the CDC’s flu burden data, we’re comparing apples to oranges. The CDC data are estimates, statistical analysis of the data at hand. The coronavirus death toll is, instead, actual tallied data from health-care providers in each state.
The CDC collects equivalent data for the flu. In the 2017-2018 season, the deadliest in recent years, here’s the number of recorded flu deaths each week. (About 15,000 deaths were directly recorded in the CDC’s weekly data, a quarter of the eventual estimated toll.)
How do the covid-19 deaths in 2020 compare? In the week of April 12, the country recorded about as many deaths as were recorded in the entirety of the 2017-2018 flu season.
The coronavirus is simply deadlier than the seasonal flu. There are a number of reasons for that, which we’ll get into. That statement is also not true across age groups; younger people are at more risk from the flu than from covid-19. But overall, the coronavirus leads to more deaths.
If we compare the CDC’s estimated number of flu deaths each year to the estimated number of symptomatic cases, we get a range of less than 0.1 percent to a bit under 0.3 percent fatality.
If we compare the number of recorded coronavirus deaths to the number of cases, offsetting the comparison by two weeks to account for the progression of the disease, we see a fairly steady fatality rate of just under 2 percent since the beginning of July. (It’s likely that the percentage was higher in earlier months both because of limited testing and subsequent improvements in treatment.)
In other words, these data suggest that for every 10,000 symptomatic flu cases in a bad year, we might see 30 deaths. In the same number of confirmed coronavirus cases, we could expect to see 175.
Death is not the only negative effect of the virus. Since March, we’ve learned that many people infected with the virus feel its effects for months: difficulty breathing, inability to exert themselves physically, recurring pain. We believe that the virus can cause long-term damage to organs beyond the lungs, damage that isn’t a common feature of bouts of influenza.
We also can’t ignore that the coronavirus numbers are tempered by precisely the sorts of things Trump waved off in his tweet on Tuesday. The death toll is where it is because people stopped interacting socially the way they normally do. It’s where it is because they wore masks. There is a flu vaccine, but not everyone gets it, with tragic results. There was and is no vaccine for the coronavirus, meaning that it posed a unique and novel threat, one that the country addressed by applying the strategies that Trump now tries to claim are unnecessary.
It’s like an NFL player pointing to the number of head injuries that occur in the public each year to argue that helmets aren’t necessary during football games. Or, in this case, it’s like a guy who was carted off the field after a rough tackle and taken to his team’s top-tier training facility standing up and declaring that everyone should play tackle football every day without wearing helmets or pads. People break bones every day but don’t go around wearing pads everywhere! What’s the big deal!
That Trump’s gone full circle on comparing the virus to the flu is both surprising and not. It’s surprising just from the standpoint that one expects adult humans to incorporate new information into their decision-making processes. But it’s not because we’re nearly four years into Trump’s presidency. That he has thrown out obvious expertise in favor of a politically useful shortcut is entirely in keeping with what we’ve come to expect.